The findings of a follow-up review examining Betsi Cadwaladr University Health Board’s governance arrangements have been published today.

The report, a joint piece of work between Healthcare Inspectorate Wales (HIW) and the Wales Audit Office (WAO), provides a progress report on the corporate, clinical and financial challenges facing the Health Board following a report last year that identified failings in governance and management arrangements.

The high level review examined the progress made against the 24 recommendations made in last year’s report, including the effectiveness of the board, the organisation’s management and clinical leadership structures, quality and safety governance arrangements, the Health Board’s ability to manage it finances and the development of strategic plans for modernisation and reconfiguration of clinical services across North Wales.

Whilst there is evidence of progress against some of the recommendations made in last year’s report, a number of the key challenges identified last year remain and the Health Board still has more work to do before its governance and management arrangements can be seen as fully fit for purpose

Since the original review 12 months ago there have been significant changes in senior personnel at the Health Board with a new Chair, Vice Chair, Chief Executive, Medical Director and Executive Nurse Director being appointed. This has provided fresh impetus and new leadership perspectives in a number of key areas. However, the pace of change has been slowed by the length of time it has taken to replace the Chief Executive.

The review points to progress in the way that board meetings now operate and how board members are supported, and highlights that necessary improvements are being made to infection prevention and control arrangements in the Health Board

However, significant challenges still remain, particularly in relation to providing clarity over the future shape of clinical services across North Wales and addressing the Health Board’s precarious financial position, with a significant deficit already being forecast for the end of the current financial year.

Urgent action is needed to review the Health Board’s organisational structure, to strengthen internal accountabilities for delivering safe and effective services, to improve the timeliness of responses to complaints and serious incidents, and to strengthen the Health Board’s planning capacity.

Chief Executive of HIW, Kate Chamberlain stated: “I am encouraged to see that there has been some progress in tackling the concerns raised in relation to the governance arrangements and procedures at the Health Board. It is clear that there is still work required to ensure that the Health Board can identify, tackle and learn from issues that have arisen in relation to quality and safety of patient care.

While progress has been made, matters such as this will need to be treated with urgency if the Health Board is to rebuild confidence amongst staff, stakeholders and the people it serves.”

Auditor General for Wales, Huw Vaughan Thomas said: “Large scale changes in senior personnel at the Health Board in the wake of last year’s report mean the Board is very much in transition. Despite this there has been progress in addressing our recommendations, most notably into how the board operates and a renewed focus at the top level on quality and safety arrangements.

There are a number of challenges for the Health Board and with a new Chief Executive now in place, the pace at which these key challenges are tackled must increase in particular to address the need to make urgent progress in securing a model of services for North Wales that is clinically and financially sustainable.”